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Schema Therapy Worksheet

Schema, mode and coping style for one moment

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Schema therapy works three layers at once: the schema (the old belief formed when a core childhood need went unmet), the mode you are in when it fires, and the coping style that keeps it intact. Fill this in for one recent situation that stung more than it should have.

The situation — what happened, in one or two factual lines
The feeling, and where it landed in the body
The belief that came with it, in the schema's own words ('I am…', 'people will…')
Which schema this looks like (see the checklist page)
Which mode I was in — vulnerable child, angry child, punitive parent, detached protector, overcompensator
How I coped — surrendered, avoided, or overcompensated — and what that cost
How true the belief felt in the moment
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How true it looks now, reading it back
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What the childhood origin of this belief probably is (roles only, no names)
What my Healthy Adult would say to the part of me that believed it
One thing I will do differently the next time this fires
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